MORE ABOUT DR. KIM’S APPROACH TO RHINOPLASTY
Out with the old ... in with modern techniques
Traditional rhinoplasty is typically a reductive surgery. Historically, the earliest rhinoplasties were performed to remove a hump, narrow the nose, and elevate the tip of the nose. Traditional techniques use incisions inside the nostrils to get access to the cartilage and bone. Because access and visibility is limited through this approach, it is not always possible to restore the areas of the nose that are weakened as a result of surgery. Therefore the nose may have a risk of undergoing collapse, pinching, or breathing obstruction following surgery.The best rhinoplasty surgeons, like David W. Kim, MD, prefers an open structural approach, which uses similar incisions as internal approaches, but also uses a small incision (few millimeters) across the narrow bridge of skin between the nostrils. Within a few weeks the skin incision heals and becomes nearly invisible and hidden under the shadow of the base of the nose. The open structural approach allows for direct exposure of the cartilage and bone.
Whereas traditional nasal surgery is one largely of “feel”, the open structural approach is one of direct visualization. Simply put, the surgeon can see what s/he is doing. More significantly, the exposure allows for strengthening or re-stabilization of the structurally important areas of the nose.
Many traditional rhinoplasty techniques involve cutting, removing, or weakening nasal cartilage and bone in order to create changes in shape. The structural approach used by Dr. Kim, emphasizes the reorientation and re-structuring of cartilage and bone in order to change nasal shape while preserving nasal strength. This leads to more predictable improvements that endure over time.
Surgical and Recovery Details
Nasal surgery is typically performed in an accredited hospital operating room or outpatient surgery center. Depending on your health and age, some pre-operative tests may need to be completed, at least a week ahead of surgery. All medications and supplements that have the potential to thin the blood (aspirin, ibuprofen, anti-coagulants) must be stopped for one month prior to surgery.Nasal surgery usually takes two and one-half to four hours depending on the complexity of the procedure. Almost all rhinoplasties are done under general anesthesia, as it is safer and more controlled than awake surgery.
Tape and a thin plastic cast are placed on the nose at the end of surgery, and there may be thin plastic stents on either side of the nasal septum inside the nose. Very tiny sutures are used to close the incision of the skin at the base of the nose. All of the sutures inside the nose are absorbable and will fall out on their own.
After surgery, the patient is taken to the recovery room where s/he can rest for 1-2 hours prior to discharge home. Patients will need someone to drive them home after discharge.
Possible Complications
Any surgery can result in excessive bleeding or infection. The incidence of these problems are very low (less than 5% of the time) and are easily taken care should they occur. For a healthy person more serious complications related to anesthesia are extremely unlikely.
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After Nasal Surgery
When discharged from the surgery center, each patient is given a prescription for pain medication, antibiotics, and ointment for the incisions. The pain medications should be used on an as-needed basis, and the antibiotics and ointment should be taken regularly for one week.The first day or two after nasal surgery patients may feel fairly tired as they recover from the immediate effects of the operation and anesthesia. Some people may experience mild nausea, nasal pressure, or headache during this period. Surgical pain is typically mild to moderate and is easily controlled with the pain medication prescribed.
The pain soon subsides, but a feeling of mild pressure inside the nose may persist for a few more days. It will be more difficult to breath through the nose for the first week until the swelling inside the nose subsides and the internal splints (if used) are removed.
Avoid Heavy Activity
For the first week following nasal surgery, patients should limit heavy activity or exertion and try to sleep with extra pillows so that the head is slightly elevated. The external cast on the nose must be kept dry. Bruising around the eyes occurs in less than half of cases and only if work on the nasal bones is required. If it occurs, bruising is typically mild and will fade within about 2 weeks.Dr. Kim likes to see patients 4 - 6 days after surgery. During this visit, the external cast, tape, and sutures are removed. The nose is at its most swollen at this point, so the patient must understand that the nose is the furthest from its final shape at this moment.
Patients must continue to refrain from heavy lifting or exertion until about three weeks after nasal surgery. At that point, they can slowly resume exercise, but should monitor the nose for swelling after exertion. If the nose throbs or becomes visibly swollen, exercise should be put off for another few days.
Additional Post-Op Appointments
The second post-operative visit occurs about two weeks after surgery. The internal splints are removed and the nose is carefully examined. At this point, the swelling will have started to subside, though the process will continue for months.Three to four visits are usually necessary in the first two months so that Dr. Kim can carefully monitor the nose as swelling subsides. This is just one of the factors that makes him one of the best rhinoplasty surgeons. Even after nasal surgery, measures can be taken to address ongoing issues in the nose, if any.
Depending on the extensiveness of surgery, patient skin thickness, and level of activity, how long swelling continues can be quite variable. On average, about half the swelling is gone at about one month. By three months about 70% of the swelling has resolved. After this point, the rest of the swelling will disappear slowly over years. Most patients feel comfortable returning to work or social settings 1-2 weeks after nasal surgery, recognizing that the nose will gradually take better form in the following weeks.
Because continued contracture and the “shrink wrap” effect of the skin onto the structure of the nose will go on for years, Dr. Kim's structural approach is important for long-term positive results from rhinoplasty. The nose must be formed into an orientation that may appear slightly wider than ideal at first so that it can be of ideal size and proportion for the lifetime of the patient.
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